Eficacia de plantillas y zapatos terapéuticos en la reducción de la incidencia de ulceración en pacientes con neuropatía diabética: una revisión sistemática con metaanálisis / Efficacy of insoles and therapeutic shoes in the reduction of the ulceration incidence in diabetic neuropathy patients: A Systematic Review with meta-analysis

Objetivo Investigar el nivel de eficacia de plantillas personalizadas y zapatos terapéuticos en la reducción de la presión plantar y la incidencia de ulceración en presencia de neuropatía diabética. Metodología Las bases de datos PubMed, Scopus, Web of Science, Cinahls, Central Cochrane y Lilacs fueron encuestados en enero de 2020. Se incluyeron ensayos clínicos aleatorizados (ECA) que reportaron pacientes con neuropatía diabética sometidos a intervención con plantillas y calzado terapéutico en comparación con un grupo control. La calidad de las publicaciones se evaluó mediante la escala PEDro y la evidencia mediante la clasificación GRADE. En cuanto al metaanálisis, se realizó la agrupación de datos homogéneos y comparables. Resultados Se incluyeron 11 estudios, lo que resultó en una muestra de 1.443 participantes. Siete artículos presentaron datos suficientes para el metaanálisis. En el corto plazo, el riesgo relativo de protección fue de 0,23 (IC 95%; 0,07; 0,72), mientras que en el largo plazo el riesgo fue de 0,32 (IC 95%; 0,21; 0,48). La escala GRADE señaló baja calidad de evidencia en cuanto a la protección a corto plazo y alta calidad a largo plazo En el análisis cualitativo, seis estudios concluyeron que hubo reducción en la presión plantar del grupo de intervención. Conclusión Se encontró efecto protector del uso de plantillas en el desarrollo de úlceras a corto y largo plazo. (AU)

Objective To investigate the level of efficacy of personalized insoles and therapeutical shoes in plantar pressure and ulceration incidence reduction in the presence of diabetic neuropathy. Methodology The data bases PubMed, Scopus, Web of Science, Cinahls, Central Cochrane and Lilacs were surveyed in January/2020. Randomized clinical trials (RCT) were included that reported diabetic neuropathy patients submitted to intervention with insoles and therapeutical shoes compared to a control group. The quality of the publications was evaluated using the PEDro scale and the evidence by the GRADE classification. Regarding the meta-analysis, the grouping of homogeneous and comparable data was carried out. Results Eleven studies were included, which resulted in a sample containing 1,443 participants. Seven papers presented enough data for the meta-analysis. In the short term, the protection relative risk was 0.23 (IC95% 0.07;0.72), while in the long term, the risk was 0.32 (IC95% 0.21;0.48). The GRADE scale pointed out low evidence quality regarding short-term protection and high quality in the long term. In the qualitative analysis, six studies concluded that there was reduction in the plantar pressure of the intervention group. Conclusion Protective effect of using insoles was found in the development of ulcers in the short and long term. (AU)

Pre- and post-surgical evaluation of the impact on Hansen disease sequealae patients' quality of life submitted to orthopedic surgery for closure of chronic plantar ulcers.

INTRODUCTION: Leprosy is a chronic infectious disease that still persists as a public health problem in Brazil. Plantar ulcers are serious complications due to leprosy neuropathy and intensify the isolation and stigma of these individuals. The difficulty in closing these lesions associated with the fetid odor negatively impact the quality of life of people with these lesions. OBJECTIVE: To evaluate the clinical, socioeconomic conditions, degree of satisfaction and quality of life (QoL) of patients after healing of chronic ulcers on feet submitted to orthopedic surgery. METHODOLOGY: This is a qualitative, exploratory, descriptive and observational study carried out with 92 people after surgical treatment of chronic leprosy plantar ulcers. These patients were submitted to a semi-structured questionnaire raising questions of an epidemiological, socioeconomic and perception of quality-of-life order, comparing before and after the surgical procedure. RESULTS: Decrease in indicators - alcohol consumption, tobacco consumption, average monthly cost of analgesic medications, fetid wound odor, foot pain and number of dressings performed weekly; Recurrence of lesions in 55.4 % of cases, related to irregular use or lack of shoes and insoles; Improvement in self-perception of Quality of Life (QoL) in 89.1 % of patients after surgery. CONCLUSION: Orthopedic surgical treatment with resection of plantar bony prominences and skin grafting is an effective therapeutic method for closing chronic plantar ulcers in leprosy, resulting in a decrease in the financial costs employed and in an important improvement in the Quality-of-Life parameters of the individuals undergoing to this procedure. The availability and regular use of shoes and insoles is crucial to prevent recurrence of these injuries.

Prevalence of plantar ulcer and its risk factors in leprosy: a systematic review and meta-analysis.

BACKGROUND: Plantar ulcers are a leading complication of leprosy that requires frequent visits to hospital and is associated with stigma. The extent of burden of ulcers in leprosy and its risk factors are scant impeding the development of targeted interventions to prevent and promote healing of ulcers. The aim of this review is to generate evidence on the prevalence of plantar ulcer and its risk factors in leprosy. METHODS: Databases (Medline, Embase, Web of Science, CINAHL, BVS), conference abstracts and reference lists were searched for eligible studies. Studies were included that reported a point prevalence of plantar ulcer and/or its "risk factors" associated with development of ulcers (either causatively or predictively), including individual level, disease related and bio-mechanical factors. We followed PRISMA guidelines for this review. Random-effects meta-analysis was undertaken to estimate the pooled point prevalence of ulcers. Reported risk factors in included studies were narratively synthesised. This review is registered in PROSPERO: CRD42022316726. RESULTS: Overall, 15 studies (8 for prevalence of ulcer and 7 for risk factors) met the inclusion criteria. The pooled point prevalence of ulcer was 34% (95% CIs: 21%, 46%) and 7% (95% CIs: 4%, 11%) among those with foot anaesthesia and among all people affected by leprosy, respectively. Risk factors for developing ulcers included: unable to feel 10 g of monofilament on sensory testing, pronated/hyper-pronated foot, foot with peak plantar pressure, foot with severe deformities, and those with lower education and the unemployed. CONCLUSIONS: The prevalence of plantar ulceration in leprosy is as high as 34% among those with loss of sensation in the feet. However, the incidence and recurrence rates of ulceration are least reported. The inability to feel 10 g of monofilament appears to be a strong predictor of those at risk of developing ulcers. However, there is a paucity of evidence on identifying those at risk of developing plantar ulcers in leprosy. Prospective studies are needed to estimate the incidence of ulcers. Identifying individuals at risk of ulcers will help design targeted interventions to minimize risk factors, prevent ulcers and promote ulcer healing.

Epidemiological clinical profile and closure of chronic plantar ulcers in patients with leprosy sequelae undergoing orthopedic surgery in a municipality in western Amazon.

INTRODUCTION: Chronic plantar ulcers in leprosy are lesions resulting from motor and sensory alterations caused by Mycobacterium leprae. They are lesions refractory to conventional dressings and present high recurrence rates. OBJECTIVE: To evaluate the epidemiological clinical profile of patients with chronic plantar ulcers associated with bony prominences in the lesion bed and to evaluate the efficacy of orthopedic surgical treatment of these lesions. METHODS: This is a descriptive and analytical retrospective study with the evaluation of medical records of patients undergoing surgical treatment of chronic plantar ulcers from 2008 to 2018. The surgical technique applied consisted of corrective resection of bone prominences and the primary closure of the lesion with bipediculated local flap. RESULTS: 234 patients were submitted to surgery, 55.1% male with an average age of 69.5 years old. Of these, 82.9% were illiterate; and 88.5% with open lesions over 10 years. After surgical treatment, total wound healing occurred in an average time of 12 weeks. The variables that contributed to shorter healing time were: Patients' lower age group; regular use of orthopedic shoes and insoles and dressings performed by nurse aides in health units before surgery. Obesity was the factor that correlated with the delay of healing time. CONCLUSION: A higher incidence was observed in males and male and female illiterate patients. The regular use of shoes and insoles and dressings performed by nurse aides in health units contributed to shorter postoperative healing time. Orthopedic surgical treatment with corrective resection of bony prominences proved to be an efficient therapeutic method for the closure of chronic plantar ulcers. It is a reproducible method, justifying the importance of the orthopedic surgeon in the context of the multidisciplinary team to cope with these complex lesions.

The efficacy of topical adipose mesenchymal stem cell-conditioned medium versus framycetin gauze dressing in chronic plantar ulcer of leprosy: A randomized controlled trial.

Background Wound healing shows a unique interaction of several cells, growth factors and cytokines. The healing of chronic plantar ulcer of leprosy is influenced by various factors, one of which is the concentration of growth factors and cytokines related to the pathogenesis of impaired wound healing. Growth factors and cytokines can be found in the secretome of adipose mesenchymal stem cells. Aim To compare the effectiveness of topical adipose mesenchymal stem cell-conditioned medium and framycetin gauze dressing only on the healing of chronic plantar ulcer of leprosy. Methods In this randomised controlled trial, 32 patients with chronic plantar ulcer of leprosy were recruited. After detailed clinical and initial debridement, patients were randomised to two groups to receive either topical adipose mesenchymal stem cell-conditioned medium (n = 16) or framycetin gauze dressing only (n = 16) applied every three days for up to eight weeks, following which the ulcer size, adverse reactions and complications if any were monitored weekly. Results Healing percentage increased each week in all groups. Statistical differences between groups (P < 0.05) were observed from week 2 onwards for ulcer mean size reduction and from week 3 onwards for ulcer mean depth reduction. There were no adverse reactions or complications. Limitations Off-loading on subjects were not performed. Conclusion Adipose mesenchymal stem cell-conditioned medium is a potential therapeutic agent in the management of chronic plantar ulcer of leprosy.

Dr E W Price, the discoverer of podoconiosis.

A straightforward biography of Dr E W Price, the discoverer of podoconiosis, a medical missionary who was also the first to elucidate plantar ulcers in leprosy.

Eficácia e eficiência das palmilhas na prevenção e reabilitação de ulceras plantares em pés neuropaticos na hanseníase e diabetes / Efficacy and efficiency of insoles in the prevention and rehabilitation of plantar ulcers in neuropathic feet in leprosy and diabetes

As neuropatias periféricas causadas pela hanseníase e diabetes podem causar perda de sensibilidade protetora, trofismo muscular e função autonômica da pele, e consequentemente deformidades em pés e desequilíbrios biomecânicos e da distribuição da pressão, gerando alto risco de desenvolvimento de úlceras plantares. Um dos meios para prevenir é o uso de palmilhas customizadas associadas ou não ao uso de calçados ortopédicos. O objetivo dessa revisão foi verificar a eficácia, eficiência das palmilhas na prevenção e reabilitação de úlceras plantares e conhecer novidades acerca do design e do material. Foram realizadas pesquisas nas plataformas PUBMED, LILACS, EMBASE e Cochrane e foram incluídos todos os modelos de artigos, livros, monografias, no total foram encontrados 17 estudos. Apesar das palmilhas serem eficazes no alívio de pressão plantar e na diminuição da incidência das ulceras plantares, neste estudo foi encontrado poucas evidências sobre inovações e durabilidade das palmilhas que levassem em conta o custo benefício e sua efetividade.

Efficacy of topical epigallocatechin gallate (EGCG) 1% on the healing of chronic plantar ulcers in leprosy.

BACKGROUND: Chronic plantar ulcers in leprosy (CPUL) occur in areas that have a sensory and an autonomic nerve impairment where the wound healing takes longer. Framycetin gauze dressing (FGD) is best used in the wound healing process during the inflammatory phase because it contains antibiotics. Epigallocatechin gallate (EGCG) is the highest component in the extract of green tea that can accelerate blood vessel formation, has an anti-inflammatory effect, and reepithelialization. OBJECTIVE: To investigate the effect of topical EGCG 1% on the healing of CPUL. MATERIALS AND METHODS: An analytical experimental approach comparing the topical EGCG 1% and FGD applied every 3 days up to 8 weeks on the healing of CPUL. Size of the ulcers, side effects and possible complications from both approaches were monitored weekly. RESULTS: Ulcer healing in the EGCG group was significantly better than the FGD group with significant clinical and statistical differences (p < .032). There were no side effects in both the study groups. Complications, such as an increase in the size of the ulcer, were noted in one subject in the control group. This may have been caused by FGD and claw foot condition. CONCLUSIONS: EGCG 1% is more effective than FGD in accelerating the healing process of CPUL.

Comorbidities associated with non- healing of plantar ulcers in leprosy patients.

BACKGROUND: Non-healing plantar ulcers are one of the significant causes of disability in leprosy patients. Plantar ulcers often take months or years to heal, affecting the patient's quality of life. Presence of comorbid conditions in these patients can delay wound healing. The study aimed to evaluate the role of associated comorbid conditions as risk factors in ulcer healing. METHODOLOGY/PRINCIPAL FINDINGS: A total of 66 leprosy patients with plantar ulcers registered at LEPRA Society-Blue Peter Public Health and Research Center (BPHRC), Hyderabad, India from June 2018 to June 2019 were studied. Comprehensive clinical assessment was done, including screening for comorbid conditions and treated as per the recommended guidelines. About two-thirds of the participants were aged 50 and above, of which more than half were illiterates, and 93.5% were living below the poverty line. Majority of ulcers were seen on the forefoot; with the head of meta-tarsal bone 27 (41.6%) as the commonest site, followed by calcaneum 23 (38.3%) and great toe 10 (16.6%). Mean ulcer depth was 0.61 (0.57) cm, the area was 5.24 (6.73) cm2 and ulcer volume was 4.72 (14.33) cm3. Ulcer dimensions were significantly associated with low body mass index, hypertension and smoking. CONCLUSIONS/SIGNIFICANCE: Identifying the risk factors delaying wound healing and detailed assessment of ulcers are of profound importance to predict the outcome of plantar ulcers in leprosy patients. The study findings indicate the need for better policies by the leprosy control program for the comprehensive management of plantar ulcers.

Efficacy of Topical Insulin Therapy for Chronic Trophic Ulcers in Patients with Leprosy: A Randomized Interventional Pilot Study.

BACKGROUND: Chronic trophic ulcers (CTUs), especially those located over the plantar region, are a leading cause of deformity and disability in patients with leprosy. Despite the various treatment modalities available, CTUs can be chronic and refractory to treatment. The successful use of topical insulin in various types of wounds led researchers to evaluate its safety and efficacy in the treatment of plantar CTUs. METHODS: Forty-two patients who had completed a multidrug treatment for leprosy were recruited and randomized into two groups. In the test group, 23 patients received 10 units (0.1 mL) of topical insulin (Actrapid) in 1 mL of normal saline twice daily over treated areas. The placebo group (n = 19) received topical normal saline only. The primary end point was the proportion of patients with complete wound closure by 12 weeks. Secondary end points included time to healing, wound area reduction, Physician Global Assessment of Efficacy scores, and Dermatology Life Quality Index scores at the end of 12 weeks. RESULTS: The majority of CTUs (80%) were situated over the forefoot; the metatarsal head of the hallux was the most common site (86%). Wound healing was faster (0.61 ± 0.31 vs 0.14 ± 0.42 cm per week, P < .0001), and the number of days to complete healing was significantly shorter in the test group compared with the placebo group (31.5 ± 17.6 vs 44.3 ± 16.2 days, P = .02). The only observed adverse effect in the test group was white granular deposits over the CTU (n = 10). CONCLUSIONS: Topical insulin therapy may be a safe, efficacious, cheap, and easily available treatment option in CTUs among patients with leprosy.

Tratamento da úlcera plantar devido à hanseníase / Treatment of leprosy-induced plantar ulcers

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.

Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.

Fatores de risco para a ocorrência das úlceras plantares decorrente da hanseníase de acordo com a árvore de decisão / Risk factors for plantar ulcers from leprosy according to the decision tree

Objective:To identify the risk factors for plantar ulcers in patients with leprosy.Methods:This is an epidemiological, observational, cross-sectional and analytical study. The population was composed of leprosy cases reported from 2005 to 2016. Pearson's Chi-square test or Fisher's exact test andMann-Whitney test were used for the univariate analysis, with a statistical significance of 5% (p < 0.05). In the multivariate analysis, a decision tree was elaborated using the CHAID algorithm. Results:Clinical form, degree of physical incapacity at discharge, affected nerve and the lack of insoles or adapted footwear before appearing to ulcer are risk factors for plantar ulcer. Conclusion:the need for an early diagnosis of leprosy was highlighted, as well as the efficient association of non-drug interventions with disability prevention techniques and the use of accommodating insoles and/or special shoes.

Objetivo:Identificar os fatores de risco para a ocorrência das úlceras plantares em pacientes com hanseníase. Métodos:Trata-se de um estudo epidemiológico, do tipo observacional, transversal e analítico. A população foi composta pelos casos de hanseníase notificados no período de 2005 a 2016. Para a análise univariada foram utilizados os testes Qui-quadrado de Pearson ou teste exato de Fisher e teste de Mann-Whitney, com significância estatística de 5% (p < 0,05). Na análise multivariada, foi elaborada árvore de decisão utilizando o algoritmo CHAID. Resultados: A forma clínica, grau de incapacidade física na alta, nervo acometido e o não uso de palmilhas ou calçado adaptado antes de surgir a úlcera são fatores de risco para a ocorrência de úlcera plantar. Conclusão:evidenciou a necessidade do diagnóstico precoce da hanseníase, como também da eficiente associação das intervenções medicamentosas e não medicamentosas por meio das técnicas de prevenção de incapacidade e uso de palmilhas acomodativas e/ou calçados especiais

Plantar ulcer occurrence among leprosy patients in Northern Nigeria: A study of contributing factors.

Background: The study was conducted in three major leprosy referral hospitals in Northern Nigeria, which are NKST Rehabilitation Hospital, Benue State, Yadakunya Leprosy Hospital, Kano, and National Tuberculosis/Leprosy Training Hospital, Zaria. The main objective of the study was to investigate factors responsible for the occurrence of ulcers among leprosy patients reporting to the leprosy referral hospitals. Materials and Methods: An analytic study of case-control design was used, with patients having plantar ulcers as cases and those without as control. Semi-structured was administered to all cases and controls. Results: A total of 242 patients were studied; 124 patients (51.2%) had plantar ulcers whereas 118 (48.8%) had no ulcers (controls). A Chi-square test was used in the analysis to compare cases and controls. The study found differences between cases and controls with respect to patients release from treatment (RFT), gender, availability and utilization of footwear, age, occupation, and educational status. Footwears were provided to most patients, i.e. 60.8% late (i.e., after developing plantar ulcers); however, there was very good utilization of the footwears among those who had the footwears, 65.3%. Knowledge of self-care was higher among 64.5% of cases compared to only 28.1% of the controls. Conclusion: Ulcer still remains a major problem among leprosy patients, especially RFT (76.6%) and most cases are provided with footwear late. Self-care knowledge is higher among cases than controls.

RésuméContexte: L'étude a été menée dans trois hôpitaux majeurs de référence pour la lèpre dans le nord du Nigéria, qui sont l'hôpital de réadaptation NKST, l'État de Benue, l'hôpital de la lèpre de Yadakunya, Kano et l'hôpital national de la tuberculose et de la lèpre, Zaria. L'objectif principal de l'étude était d'étudier les facteurs responsables de l'apparition d'ulcères chez les patients atteints de lèpre signalant des hôpitaux de référence pour la lèpre. Matériaux et méthodes: une étude analytique de la conception cas-témoins a été utilisée, les patients ayant des ulcères plantaires comme cas et ceux qui n'ont pas le contrôle. Semi-structuré a été administré à tous les cas et contrôles. sRésultats: Au total, 242 patients ont été étudiés; 124 patients (51,2%) avaient des ulcères plantaires tandis que 118 (48,8%) n'avaient pas d'ulcères (témoins). Un test du Chi-carré a été utilisé dans l'analyse pour comparer les cas et les témoins. L'étude a révélé des différences entre les cas et les contrôles par rapport aux patients libérés du traitement (RFT), le sexe, la disponibilité et l'utilisation de la chaussure, l'âge, la profession et le statut scolaire. Les chaussures ont été fournies à la plupart des patients, soit 60,8% en retard (c'est-à -dire après développement d'ulcères plantaires); cependant, il y avait une très bonne utilisation des chaussures parmi ceux qui avaient les chaussures, soit 65,3%. La connaissance de l'autosoins était plus élevée chez 64,5% des cas que dans seulement 28,1% des témoins. Conclusion: L'ulcère reste un problème majeur chez les patients atteints de lèpre, en particulier les TF (76,6%) et la plupart des cas sont munis de chaussures en retard. La connaissance des soins personnels est plus élevée parmi les cas que les témoins.

Non-contact ulcer area calculation system for neuropathic foot ulcer.

BACKGROUND: Around 125,785 new cases in year 2013-14 of leprosy were detected in India as per WHO report on leprosy in September 2015 which accounts to approximately 62% of the total new cases. Anaesthetic foot caused by leprosy leads to uneven loading of foot leading to ulcer in approximately 20% of the cases. Much efforts have gone in identifying newer techniques to efficiently monitor the progress of ulcer healing. Current techniques followed in measuring the size of ulcers, have not been found to be so accurate but are still is followed by clinicians across the globe. Quantification of prognosis of the condition would be required to understand the efficacy of current treatment methods and plan for further treatment. This study aims at developing a non contact technique to precisely measure the size of ulcer in patients affected by leprosy. METHODS: Using MATLAB software, GUI was designed to process the acquired ulcer image by segmenting and calculating the pixel area of the image. The image was further converted to a standard measurement using a reference object. The developed technique was tested on 16 ulcer images acquired from 10 leprosy patients with plantar ulcers. Statistical analysis was done using MedCalc analysis software to find the reliability of the system. RESULTS: The analysis showed a very high correlation coefficient (r=0.9882) between the ulcer area measurements done using traditional technique and the newly developed technique, The reliability of the newly developed technique was significant with a significance level of 99.9%. CONCLUSIONS: The designed non-contact ulcer area calculating system using MATLAB is found to be a reliable system in calculating the size of ulcers. The technique would help clinicians have a reliable tool to monitor the progress of ulcer healing and help modify the treatment protocol if needed.

Polyhexanide 0.2% in treatment of trophic foot ulcers in leprosy - preliminary study.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects peripheral nerves, skin and mucous membranes. The impairment of neural function as well as sensory or sensory-motor disabilities in leprosy continue to be a problem that requires careful attention in the management of patients with the aim to avoid or minimize their progression to prevent sequelae. One of the most common characteristics of these ulcers is the tendency to chronicity, with variable therapeutic response. In this article, we shall discuss the therapeutic management of thirteen trophic leprosy ulcers in eight patients using polyhexanide 0.2% products.

The efficacy of topical human amniotic membrane-mesenchymal stem cell-conditioned medium (hAMMSC-CM) and a mixture of topical hAMMSC-CM + vitamin C and hAMMSC-CM + vitamin E on chronic plantar ulcers in leprosy:a randomized control trial.

BACKGROUND: Healing of chronic plantar ulcers in leprosy (CPUL) typically takes a long time due to impaired neurological function, thereby reducing the levels of growth factors and cytokines. Cytokines can be found in metabolite products from amniotic membrane stem cells. Chronic ulcers are frequently characterized by high levels of reactive oxygen species. Vitamin E (α-tocopherol) is widely used in skin lesions, owing to its antioxidant and anti-inflammatory properties. Vitamin C also has antioxidant, anti-inflammatory, and collagen synthesis properties which are useful in wound healing. Herein, we compared the effects of topical human amniotic membrane-mesenchymal stem cell-conditioned medium (hAMMSC-CM) alone and with vitamins C and E on healing of CPUL. METHODS: In this randomized controlled trial, topical agents were applied every 3 days for up to 8 weeks. Ulcer size, side-effects, and possible complications were monitored weekly. RESULTS: Healing percentage increased each week in all groups. Mean difference in ulcer size was highest in the hAMMSC-CM + vitamin E group, implying better progress of wound healing. There were no side-effects or complications. CONCLUSIONS: hAMMSC-CM + vitamin E is best for healing of CPUL.

Polyhexanide 0 2% in treatment of trophic foot ulcers in leprosy - preliminary study

Abstract: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects peripheral nerves, skin and mucous membranes. The impairment of neural function as well as sensory or sensory-motor disabilities in leprosy continue to be a problem that requires careful attention in the management of patients with the aim to avoid or minimize their progression to prevent sequelae. One of the most common characteristics of these ulcers is the tendency to chronicity, with variable therapeutic response. In this article, we shall discuss the therapeutic management of thirteen trophic leprosy ulcers in eight patients using polyhexanide 0.2% products.